Individual
DR. JACK M. BERGSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7205 54TH PL NE UNIT A, MARYSVILLE, WA 98270-8932
(724) 833-2171
(360) 386-8019
Mailing address
7205 54TH PL NE UNIT A, MARYSVILLE, WA 98270-8932
(724) 833-2171
(360) 386-8019
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD422547
PA
208600000X
Surgery Physician
Primary
MD60641501
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026626302
UNIVERA HEALTHCARE
PA
05
—
0012111170005
—
PA
01
—
147447
UNISON
PA
01
—
1548575
BLUE CROSS BLUE SHIELD
PA
01
—
305022
UPMC
PA
Enumeration date
06/19/2006
Last updated
03/17/2018
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